Indian River Residential Care Community

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

Legal business name

INDIAN RIVER RESIDENTIAL CARE COMMUNITY

Doing business as

dba Indian River Retirement Community, LLC

Practice address

1012 Justis St
Chesapeake, VA 23325-2516

Phone

(757) 523-4659

NPI assigned

Nov 28, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Guy S Pierce

Title

Managing Member

Phone

(336) 595-1075

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• dba Indian River Retirement Community, LLC Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1578639654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1487",
            "city": "KERNERSVILLE",
            "state": "NC",
            "postal_code": "272851487",
            "telephone_number": "336-595-1075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1012 JUSTIS ST",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233252516",
            "telephone_number": "757-523-4659"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIAN RIVER RESIDENTIAL CARE COMMUNITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-28",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PIERCE",
        "authorized_official_first_name": "GUY",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "336-595-1075"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "VA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5002281",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "dba Indian River Retirement Community, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.